Sex-related patterns of LDL-C/small dense LDL-C discordance among Japanese adults with non-elevated LDL-C

Abstract

Background: Low-density lipoprotein cholesterol (LDL-C) remains central to lipid-based cardiovascular risk assessment, but LDL-C alone may not fully capture residual atherogenic lipoprotein burden. Small dense LDL cholesterol (sdLDL-C) is influenced by LDL-C and triglyceride (TG)-rich lipoprotein metabolism, and elevated sdLDL-C may be overlooked when LDL-C is not elevated. Whether LDL-C/sdLDL-C discordance differs by sex across TG strata remains unclear. Methods: This cross-sectional study included 1879 Japanese adults undergoing annual health check-ups in 2020. The primary analysis included participants with LDL-C <140 mg/dL. Discordance was defined as sdLDL-C ≥35 mg/dL. Discordance prevalence was compared between men and women overall and across TG strata. Apolipoprotein B (ApoB), malondialdehyde-modified LDL (MDA-LDL), high-density lipoprotein 2 cholesterol (HDL2-C), high-density lipoprotein 3 cholesterol (HDL3-C), the HDL2-C/HDL3-C ratio, and high-molecular-weight adiponectin (HMW-adiponectin) were compared by discordance status. Results: Among participants with LDL-C <140 mg/dL, discordance was more frequent in men than in women [259/917 (28.2%) vs. 42/438 (9.6%), P < 0.001]. This sex difference persisted at TG < 150 mg/dL [16.0% vs. 4.2%, P < 0.001] and TG < 100 mg/dL [7.5% vs. 2.4%, P = 0.0015], but not at TG ≥ 150 mg/dL [74.1% vs. 71.4%, P = 0.835]. Discordant participants had higher ApoB and MDA-LDL and lower HDL2-C, HDL2-C/HDL3-C ratio, and HMW-adiponectin. Conclusions: LDL-C/sdLDL-C discordance was more frequent in men, particularly in lower TG strata, and was accompanied by an adverse atherogenic lipid profile.

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BibTeX RIS

BibTeX

@article{moriyama2026sexrelated,
  title = {{Sex-related patterns of LDL-C/small dense LDL-C discordance among Japanese adults with non-elevated LDL-C}},
  author = {Kengo Moriyama},
  journal = {Atherosclerosis Plus},
  year = {2026},
  month = oct,
  doi = {10.1016/j.athplu.2026.100616},
  url = {https://doi.org/10.1016/j.athplu.2026.100616},
  note = {CC BY},
}

RIS

TY  - JOUR
TI  - Sex-related patterns of LDL-C/small dense LDL-C discordance among Japanese adults with non-elevated LDL-C
AU  - Kengo Moriyama
PY  - 2026
DA  - 2026/10/12
JO  - Atherosclerosis Plus
DO  - 10.1016/j.athplu.2026.100616
UR  - https://doi.org/10.1016/j.athplu.2026.100616
AB  - Background: Low-density lipoprotein cholesterol (LDL-C) remains central to lipid-based cardiovascular risk assessment, but LDL-C alone may not fully capture residual atherogenic lipoprotein burden. Small dense LDL cholesterol (sdLDL-C) is influenced by LDL-C and triglyceride (TG)-rich lipoprotein metabolism, and elevated sdLDL-C may be overlooked when LDL-C is not elevated. Whether LDL-C/sdLDL-C discordance differs by sex across TG strata remains unclear. Methods: This cross-sectional study included 1879 Japanese adults undergoing annual health check-ups in 2020. The primary analysis included participants with LDL-C <140 mg/dL. Discordance was defined as sdLDL-C ≥35 mg/dL. Discordance prevalence was compared between men and women overall and across TG strata. Apolipoprotein B (ApoB), malondialdehyde-modified LDL (MDA-LDL), high-density lipoprotein 2 cholesterol (HDL2-C), high-density lipoprotein 3 cholesterol (HDL3-C), the HDL2-C/HDL3-C ratio, and high-molecular-weight adiponectin (HMW-adiponectin) were compared by discordance status. Results: Among participants with LDL-C <140 mg/dL, discordance was more frequent in men than in women [259/917 (28.2%) vs. 42/438 (9.6%), P < 0.001]. This sex difference persisted at TG < 150 mg/dL [16.0% vs. 4.2%, P < 0.001] and TG < 100 mg/dL [7.5% vs. 2.4%, P = 0.0015], but not at TG ≥ 150 mg/dL [74.1% vs. 71.4%, P = 0.835]. Discordant participants had higher ApoB and MDA-LDL and lower HDL2-C, HDL2-C/HDL3-C ratio, and HMW-adiponectin. Conclusions: LDL-C/sdLDL-C discordance was more frequent in men, particularly in lower TG strata, and was accompanied by an adverse atherogenic lipid profile.
SN  - 2667-0895
SN  - 2667-0909
ER  -

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